Institute of Population Health Sciences, University of Liverpool, Liverpool, Merseyside, UK
Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMJ Open. 2020 Oct 12;10(10):e040056. doi: 10.1136/bmjopen-2020-040056.
We assessed social inequalities in child mental health problems (MHPs) and how they are mediated by perinatal factors, childhood illness and maternal mental health in two national birth cohorts.
Longitudinal cohort study SETTING: We used data from the UK Millennium Cohort Study and the Danish National Birth Cohort.
We applied causal mediation analysis to longitudinal cohort data. Socioeconomic conditions (SECs) at birth were measured by maternal education. Our outcome was child MHPs measured by the Strength and Difficulty Questionnaire at age 11. We estimated natural direct, indirect and total effects (TEs) of SECs on MHPs. We calculated the proportion mediated (PM) via three blocks of mediators-perinatal factors (smoking/alcohol use during pregnancy, birth weight and gestational age), childhood illness and maternal mental health.
At age 11 years, 9% of children in the UK and 3.8% in Denmark had MHPs. Compared with high SECs, children in low SECs had a higher risk of MHPs (relative risk (RR)=4.3, 95% CI 3.3 to 5.5 in the UK, n=13 112; and RR=6.2, 95% CI 4.9 to 7.8 in Denmark, n=35 764). In the UK, perinatal factors mediated 10.2% (95% CI 4.5 to 15.9) of the TE, and adding maternal mental health tripled the PM to 32.2% (95% CI 25.4 to 39.1). In Denmark, perinatal factors mediated 16.5% (95% CI 11.9 to 21.1) of the TE, and including maternal mental health increased the PM to 16.9% (95% CI 11.2 to 22.6). Adding childhood illness made little difference in either country.
Social inequalities in child mental health are partially explained by perinatal factors in the UK and Denmark. Maternal mental health partially explained inequalities in the UK but not in Denmark.
我们评估了儿童心理健康问题（MHP）中的社会不平等现象，并在两个全国性的出生队列中，研究了围产期因素、儿童疾病和产妇心理健康对这些不平等现象的影响。
纵向队列研究。
我们使用了来自英国千禧年队列研究和丹麦国家出生队列的数据。
我们对纵向队列数据应用了因果中介分析。出生时的社会经济状况（SEC）由母亲的教育程度来衡量。我们的结果是通过 11 岁时的《长处与困难问卷》测量的儿童心理健康问题。我们估计了 SEC 对 MHP 的直接、间接和总效应（TE）。我们通过围产期因素（怀孕期间吸烟/饮酒、出生体重和胎龄）、儿童疾病和产妇心理健康三个中介块，计算了通过中介产生的比例（PM）。
在 11 岁时，英国有 9%的儿童和丹麦有 3.8%的儿童患有 MHP。与高 SEC 组相比，低 SEC 组的儿童患 MHP 的风险更高（英国的相对风险（RR）为 4.3，95%CI 为 3.3 至 5.5，n=13112；丹麦的 RR 为 6.2，95%CI 为 4.9 至 7.8，n=35764）。在英国，围产期因素解释了 TE 的 10.2%（95%CI 为 4.5 至 15.9），而加入产妇心理健康则使 PM 增加到 32.2%（95%CI 为 25.4 至 39.1）。在丹麦，围产期因素解释了 TE 的 16.5%（95%CI 为 11.9 至 21.1），而包括产妇心理健康则使 PM 增加到 16.9%（95%CI 为 11.2 至 22.6）。在这两个国家，加入儿童疾病对结果影响不大。
在英国和丹麦，儿童心理健康方面的社会不平等现象部分可以通过围产期因素来解释。产妇心理健康在英国部分解释了不平等现象，但在丹麦则没有。
